Magic Words in Birth

Hello, happy 2021 friends. I cannot wait to see what this year holds. And you know what, when I look back over 2020, it hadn't all been bad at, if you look at Episode 121 of The Birth Lounge Podcast, I actually talk about some of the positives that have come up for women's health from Coronavirus, specifically within the birth world. But in general, I think we're going to start to see some positive strides. I know that 2020 has been a hard year for so many people in, in the birth world. I was just actually talking to the birth workers and we were all sharing that collectively things just feel heavier in the birth space. It feels like outcomes aren't as great and that there's a lot more medical manipulation (Check out Episode 136 of the podcast on medical manipulation).

Recently, we had a really amazing birth at TBH. It was so beautiful. Total hours was only 11 hours. And this birthing person only pushed for 20 minutes and she had zero tearing and we did eight of those hours at her home and three of those hours at the hospital. It was just so idealic, it just really was, it was so beautiful and it was such a refreshing dose of how birth can be. When I came home from that birth I recorded a snippit to share within The Birth Lounge Community. And I've gone back to this clip several times over the last week, because like I was telling you, there's been this collective heaviness in the birth world and this birth was so refreshing. 

So it's just been nice to remind myself throughout these last couple of days that, you know, times are hard right now, but it doesn't mean all is lost. And if you prepare in a very intentional way, and if you prepare with the right preparation and with the right information and with the right team, then, you know, things can go beautifully. 

Even though you won't hear my voice. I feel like the message of this birth carries through in text. So, here are my thoughts at 2am after returning home from this birth:

"Hi, it is 2:15 in the morning. I just got home, but look, I just got home from a birth. Literally just walked in the door, beautiful birth. Oh my gosh. Beautiful vaginal delivery, pushed for 9 minutes. Zero tearing. Did about 11 hours of labor at home. 3 hours of labor at the hospital. It was so good, but we faced some rocky parts at the hospital and it all came down to a provider who was really struggling to respect consent and to respect the fact that this person had already shared their birth goals. And this provider just kept on suggesting and scaring and encouraging different decisions. 

At one point there was the conversation about having an IV placed, right? 

Birthing person: 'I do not want that. I have been hydrating. I do not want that.' 

Provider: 'We have to draw blood anyway and run some labs anyway. So we just need to place it.' 

Birthing person: 'No, you can just draw the blood. And then I don't want that IV'. 

Provider: 'You know, you really need to get this IV'. 

Birthing person: 'Why do I need this IV so badly? Why can't we just do this IV later if I need it?'

Provider: 'You know, if there was an emergency, the one minute that it could take to get in an IV can mean life or death for your baby'. 

Now, this statement is probably true in SOME cases, BUT the same is probably not true in a lot. In most cases. You also would hope that if someone held a job on an L and D unit, that they would hold the skill, the very core competency to place an IV in an emergency.

The way that this was presented. And the words that were used were so guttural. My heart right now is racing actually just reliving this, because it was very scary in the moment, the way that this doctor presented it. And I think it's important to note that we spend months preparing our clients to birth. We are not a traditional doula service. We are a maternity concierge service.  We're with you for months preparing you for very tiny details, exactly like this. 

This is why I want to share this with you as it plays out exactly how it is supposed to. We know that in America, we like to give IVs. So this birthing person says, 'You know, I would like to wait until an emergency arises in order to get an IV. I don't want an IV right now.' And she turns to me and says, 'Hehe, what does the evidence say?' And I say, 'Well, we know that the evidence says there is no benefit to having an IV placed. If you have been hydrating on your own, and you're not getting sick to the point that you're dehydrated and you're being able to keep down fluids, however, your doctor has a very valid reason for wanting an IV placed.' The doctor comes back with some more reasons as to why in an emergency being without an IV can be very scary. 

And again, this goes back to the skillset of, if someone is holding a job on an L and D unit, we hope that they're able to place an IV, whether it be in an emergency or not, it comes along with the job. And so this birthing person says, 'I don't want an IV'. And she turns to me and says, 'I don't want an IV'. And I said, 'I think that's fine'. 

This is where informed consent comes in. And I say, '...and this is where informed refusal comes in as well'. And you know, all about that and that provider, her tune changed. The wind in her sails went a different direction. It was like night and day. They were like, 'All right, no IV. We understand you've been hydrating. We are all set with understanding about the IV. If it comes to that, we are going to need to place it'. And the whole room was like, 'Well, of course'.

No lie. I was like, Wait, are these magic words? Did I just say magic words? I was legit taken back. I'm still taking back the whole situation when I paused the room. And I reminded everybody informed consent is definitely a thing, but that's a buzzword these days doesn't mean very much. Right? But I guess it means a lot. Everyone's talking about informed consent. 

But at some point it gets muddled. The message gets muddled. And I think that's where we've reached with informed consent. People are so tired of hearing about it. It's legitimately real. People are tired of hearing about it. So they've, they've tuned it out. That's what I'm trying to say. (Please remember. It's like 2:30 in the morning.)

Informed refusal though. It was so different. They got it. It was just a reminder. I think every now and then birth has this tendency that everyone's really caught up in the moment. And we just want to pause the room, ask our questions and then evaluate our options. And that's how you pace your birth, right? 

A provider can not practice informed consent without recognizing and respecting informed refusal, period. End of story. No negotiations. Book closed. Informed refusal and informed consent go hand in hand like this. They are best friends. You can't have one without the other it's salt and pepper, the left and the right. 

Okay. That's what I came on here to tell you, I'm riding that birth high because that birth was so the universal. It was so beautiful. And you can have it. As cheesy as that sounds, you can have that too. And this just shows how it plays out. If you do work, how it plays out. You have to do the work. We have to have these conversations. You have to know these things. You have to be educated on your choices. You have to understand your options and your rights. Be prepared to have these conversations be prepared to stand your ground.

Their business is how to support you in making sure that you do get those or you don't get those. And if you can't have your preferences that you're getting as close to those as possible, that's what we do at TBH. Thanks for hanging out with me. All right, I got to go to bed. Bye guys."

Please, remember the value of informed consent AND informed refusal.